Part II: What We Can Do About The Preceptor Problem for Nurse Practitioner Students: A Message To Students

Part I addressed the Schools.  Part II is directed towards Nurse Practitioner Students.  As mentioned in Part I, issues related to the Preceptor Problem for Nurse Practitioner Students are multi-factorial. 
 
Dear NP Students: You are the future for the profession! Keep this in mind when you are out there: We support you!  First of all, hang in there. You can get through this and will have “NP” behind your name…eventually!  For the most part, it’s a great profession with many opportunities.  Here are suggestions and input from my perspective as a NP of 20+ years and business owner: 
 
Most students are not guilty of some of the worst “offenses” mentioned here, but it only takes a few (or one!) to turn off a potential site or preceptor. Please do not think this commentary implies that I put the sole blame on students for The Preceptor Problem for NPs.  (And, yes, I have heard every one of these comments from preceptors!)  As I said, the issues are multi-factorial but this commentary addresses The Student.
 
First of all, I am sorry that it is so difficult to find a preceptor these days, but it is the reality until things change- and many things need to change.  Here are some tips in the meantime:

1. Start early. Many sites are booked a year in advance. 
2. Be a professional. Act and dress in a manner worthy of respect if you want to be valued and respected.  (Even if your preceptor doesn’t dress professionally or says jeans are ok, youdress professionally. You represent the profession.)  No mini skirts, plunging collars, studs and visible tattoos.  Save that for after work if you must. 
3. Be polite and professional at all times. Consider clinicals a trial run for a job- even if you wouldn’t work there.  Consider it a job interview. You are a reflection of NPs and future students.  If a site decides “never again” after you, that is not fair to other students!
4. Show up on time for clinicals!  Every day.  One would think I don’t need to say this, but I do. 
5. Realize the preceptor is doing you a favor, and make it as easy as possible for them. Offer to fill out paperwork so they don’t have much to do.  Be polite to office staff!  You are not their priority.  Starbucks, fruit or homemade cookies for the office will go a long way.  Again, fill paperwork out for office staff as much as possible.  Believe me, I know you are more than burdened yourself, but you have to make it as easy as possible for preceptors!
6. Regarding paperwork, as appropriate, talk to your school about simplifying paperwork for sites. If, time and time again you hear that your school’s paperwork is more burdensome than other schools, clearly there is a problem.  There is power in numbers.  Get together with your classmates and request/beg that they make changes to lesson this big problem.  (Schools- please help here!!  Not all school’s preceptor paperwork is so burdensome!)
7. Don’t be over-confident and talk about how “you can’t wait to open up YOUR own NP practice.” It’s great to have dreams, but you are just getting started, so keep those to yourself for now.
8. Don’t be too timid, but at the same time, don’t be pushy.  It’s normal to be nervous, but you have to get in there and see patients to ever get over your nerves.  Ask questions. Look things up.  Take initiative!  Take notes. Then ask and research later so as not to interrupt flow. Have some good books and apps on your phone. If you use them in clinical, explain that you are checking a medical app (even show the patient), not texting so you don’t appear rude. Most patients appreciate that we check things.
9. Don’t “correct” your preceptor in front of the patient (unless it is a life threatening mistake). Make a note and ask a polite question later. (If you really need to, slip them a subtle note.) There are many right ways to do things in medicine.
10. If you don’t know the answer, say, “Let me get back to you on that.”  Then look it up.
11. Find ways to be helpful.  Do some things for the preceptor so he/she will be less burdened while precepting. 
12. If your preceptor is not working out, try to sit down and talk to him/her and then talk to the school.  Sometimes it just doesn’t work though. See # 5 above.
13. If something happens and you will not be doing the planned clinical rotation anymore, please politely let the preceptor and office know ASAP!  This might open up a spot for some other student!  (Yes, this happens!)  It’s not fair to the preceptor or to other students who might be able to use your rotation.  This is another case where “thank you cookies” might pay it forward for other students. It is a tremendous of work to do paperwork and contracting and then be told, “Never mind, I don’t need you now.”
14. You must be flexible with your clinical dates!  If your preceptor can only take you on certain days, you must work around him/her…don’t expect anything else.  Please don’t send your preceptor the schedule you can work!  (Unless they ask for it.) Your preceptor is already taking time to precept you and will often cancel if they feel the student is being too demanding or inflexible.  We’ve seen it happen!
15. Confirm your preceptor’s vacation dates ahead of time.  Sometimes colleagues will allow you to follow them a few times.  (If your school allows this.  Schools, please allow this!)
16. Discuss what will happen if your preceptor has an unexpected absence. (See 16 above.)
17. Even if you/your school is providing an honorarium to the preceptor, please realize that this is nowhere near “payment for their time and expertise.”  It is a token of thanks.  All of the above guidelines still apply.
18. Make sure there are clear expectations and goals at the beginning of a clinical rotation.  (Understand your preceptor’s expectations regarding history taking, charting, questions, etc.  Realize that these may change as he/she assesses your abilities.)
19. Discuss all of this with your preceptor ahead of time to find out his/her preferences.  Perhaps review this commentary and get his/her take on things. This will show respect and openness to learn.
20. Breathe!  Take good care of yourself.  Eat healthy.  Pray. Meditate. Exercise. (I literally tie my laptop to my treadmill and stair-stepper and work!)  Get enough sleep.  Be kind to your family.  Don’t neglect your spouse/loved ones. Sing.  Laugh.  Support each other.  Pet a dog/horse/cat… One step at a time.  It sounds impossible, but you will get through it.  And then some day, you can be a preceptor!  And don’t forget, PreceptorLink will give you an honorarium to precept too!
21. If you can’t find a preceptor on your own, please let us know, and we will see if we can help!  http://www.preceptorlink.com/